Who makes health care decisions for me if I have no power of attorney for personal care in Ontario?

If you are incapable of making a health care decision and have no power of attorney for personal care, Ontario law sets out a hierarchy of substitute decision-makers who may give or refuse consent on your behalf.

Under the Health Care Consent Act, the hierarchy is generally: a court-appointed guardian of the person, followed by a representative appointed by the Consent and Capacity Board, then your spouse or partner, then a parent (or a Children's Aid Society for minors), then a sibling, then any other relative. The first available and willing person from this list who is at least 16 years old and capable of decision-making can act.

The problem is that this hierarchy may not reflect the person you would have chosen. Two people at the same level in the hierarchy must agree if both are present; if they disagree, the matter may go to the Consent and Capacity Board to resolve. This can be stressful and slow during a medical crisis.

If no one in the hierarchy is available or willing, the Public Guardian and Trustee becomes the default substitute decision-maker for health care consent as well. By making a power of attorney for personal care now, you remove this uncertainty and ensure that the person you trust — not the default hierarchy — is the one speaking for you.